Mental Health First Aid Registration
Name
*
First Name
Last Name
Email address
*
example@example.com- This will be the email address used for correspondence about the course.
Contact number
Mobile number 0000 000 000
Phone Number
-
Area Code
Phone Number
Are you a selectability staff member?
Yes
No
Please select the training dates you are registering for:
Organisation Booking
Thursday 28th July and Friday 29th July ROCKHAMPTON
Monday 8th August and Tuesday 9th August TOWNSVILLE
Thursday 18th August and Friday 19th August TOWNSVILLE
Saturday 3rd September and Sunday 4th September TOWNSVILLE
Are you booking as an individual or for a group?
Individual
Group
If group, please list ALL people you are booking for below
If group, please list ALL people you are booking for below
Information
Please let us know any relevant information that can assist us for delivering the course
Submit
Should be Empty: